Tài liệu NATIONAL HEALTH POLICY 2002 (India) doc

NATIONAL HEALTH POLICY 2002
(India)

1. INTRODUCTORY
1.1 A National Health Policy was last formulated in 1983, and
since then there have been marked changes in the
determinant factors relating to the health sector. Some of the
policy initiatives outlined in the NHP-1983 have yielded results,
while, in several other areas, the outcome has not been as
expected.

1.2 The NHP-1983 gave a general exposition of the policies
which required recommendation in the circumstances then
prevailing in the health sector. The noteworthy initiatives under
that policy were:-

(i) A phased, time-bound
programme for setting up a well-
dispersed network of
comprehensive primary health care
services, linked with extension and
health education, designed in the
context of the ground reality that
elementary health problems can
be resolved by the people
themselves;

(ii) Intermediation through ‘Health
volunteers’ having appropriate
knowledge, simple skills and

requisite technologies;

(iii) Establishment of a well-worked
out referral system to ensure that
patient load at the higher levels of
the hierarchy is not needlessly
burdened by those who can be
treated at the decentralized level;

(iv) An integrated net-work of
evenly spread speciality and super-
speciality services; encouragement
of such facilities through private
investments for patients who can
pay, so that the draw on the
Government’s facilities is limited to
those entitled to free use.

1.3 Government initiatives in the pubic health sector have
recorded some noteworthy successes over time. Smallpox and
Guinea Worm Disease have been eradicated from the country;
Polio is on the verge of being eradicated; Leprosy, Kala Azar,
and Filariasis can be expected to be eliminated in the
foreseeable future. There has been a substantial drop in the
Total Fertility Rate and Infant Mortality Rate. The success of the
initiatives taken in the public health field are reflected in the
progressive improvement of many demographic /
epidemiological / infrastructural indicators over time – (Box-I).

Box-1 : Achievements Through The Years - 1951-2000

Indicator
1951 1981 2000
Demographic Changes

Life Expectancy 36.7 54 64.6(RGI)
Crude Birth Rate 40.8 33.9(SRS) 26.1(99 SRS)
Crude Death Rate 25 12.5(SRS) 8.7(99 SRS)
IMR 146 110 70 (99 SRS)

Epidemiological Shifts

Malaria (cases in million) 75 2.7 2.2
Leprosy cases per 10 000
38.1 57.3 3.74
population
Small Pox (no of cases) >44,887 Eradicated
Guineaworm ( no. of cases) >39,792 Eradicated
Polio 29709 265
Infrastructure

SC/PHC/CHC 725 57,363 1,63,181
(99-RHS)
Dispensaries &Hospitals( all) 9209 23,555 43,322 (95–96-
CBHI)
Beds (Pvt & Public) 117,198 569,495 8,70,161
(95-96-CBHI)
Doctors(Allopathy) 61,800 2,68,700 5,03,900
(98-99-MCI)
Nursing Personnel 18,054 1,43,887 7,37,000
(99-INC)

1.4 While noting that the public health initiatives over the years
have contributed significantly to the improvement of these
health indicators, it is to be acknowledged that public health
indicators / disease-burden statistics are the outcome of
several complementary initiatives under the wider umbrella of
the developmental sector, covering Rural Development,
Agriculture, Food Production, Sanitation, Drinking Water Supply,
Education, etc. Despite the impressive public health gains as
revealed in the statistics in Box-I, there is no gainsaying the fact
that the morbidity and mortality levels in the country are still
unacceptably high. These unsatisfactory health indices are, in
turn, an indication of the limited success of the public health
system in meeting the preventive and curative requirements of
the general population.

1.5 Out of the communicable diseases which have persisted
over time, the incidence of Malaria staged a resurgence in
the1980s before stabilising at a fairly high prevalence level
during the 1990s. Over the years, an increasing level of
insecticide-resistance has developed in the malarial vectors in
many parts of the country, while the incidence of the more
deadly P-Falciparum Malaria has risen to about 50 percent in
the country as a whole. In respect of TB, the public health
scenario has not shown any significant decline in the pool of
infection amongst the community, and there has been a
distressing trend in the increase of drug resistance to the type
of infection prevailing in the country. A new and extremely
virulent communicable disease – HIV/AIDS - has emerged on
the health scene since the declaration of the NHP-1983. As
there is no existing therapeutic cure or vaccine for this infection,

the disease constitutes a serious threat, not merely to public
health but to economic development in the country. The
common water-borne infections – Gastroenteritis, Cholera, and
some forms of Hepatitis – continue to contribute to a high level
of morbidity in the population, even though the mortality rate
may have been somewhat moderated.

1.6 The period after the announcement of NHP-83 has also
seen an increase in mortality through ‘life-style’ diseases-
diabetes, cancer and cardiovascular diseases. The increase in
life expectancy has increased the requirement for geriatric
care. Similarly, the increasing burden of trauma cases is also a
significant public health problem.

1.7 Another area of grave concern in the public health domain
is the persistent incidence of macro and micro nutrient
deficiencies, especially among women and children. In the
vulnerable sub-category of women and the girl child, this has
the multiplier effect through the birth of low birth weight babies
and serious ramifications of the consequential mental and
physical retarded growth.

1.8 NHP-1983, in a spirit of optimistic empathy for the health
needs of the people, particularly the poor and under-
privileged, had hoped to provide ‘Health for All by the year
2000 AD’, through the universal provision of comprehensive
primary health care services. In retrospect, it is observed that
the financial resources and public health administrative
capacity which it was possible to marshal, was far short of that
necessary to achieve such an ambitious and holistic goal.

Against this backdrop, it is felt that it would be appropriate to
pitch NHP-2002 at a level consistent with our realistic
expectations about financial resources, and about the likely
increase in Public Health administrative capacity. The
recommendations of NHP-2002 will, therefore, attempt to
maximize the broad-based availability of health services to the
citizenry of the country on the basis of realistic considerations of
capacity. The changed circumstances relating to the health
sector of the country since 1983 have generated a situation in
which it is now necessary to review the field, and to formulate a
new policy framework as the National Health Policy-2002. NHP-
2002 will attempt to set out a new policy framework for the
accelerated achievement of Public health goals in the socio-
economic circumstances currently prevailing in the country.

2. CURRENT SCENARIO
2.1 FINANCIAL RESOURCES
2.1.1 The public health investment in the country over the years
has been comparatively low, and as a percentage of GDP has
declined from 1.3 percent in 1990 to 0.9 percent in 1999. The
aggregate expenditure in the Health sector is 5.2 percent of
the GDP. Out of this, about 17 percent of the aggregate
expenditure is public health spending, the balance being out-
of-pocket expenditure. The central budgetary allocation for
health over this period, as a percentage of the total Central
Budget, has been stagnant at 1.3 percent, while that in the
States has declined from 7.0 percent to 5.5 percent. The
current annual per capita public health expenditure in the
country is no more than Rs. 200. Given these statistics, it is no
surprise that the reach and quality of public health services has

been below the desirable standard. Under the constitutional
structure, public health is the responsibility of the States. In this
framework, it has been the expectation that the principal
contribution for the funding of public health services will be
from the resources of the States, with some supplementary
input from Central resources. In this backdrop, the contribution
of Central resources to the overall public health funding has
been limited to about 15 percent. The fiscal resources of the
State Governments are known to be very inelastic. This is
reflected in the declining percentage of State resources
allocated to the health sector out of the State Budget. If the
decentralized pubic health services in the country are to
improve significantly, there is a need for the injection of
substantial resources into the health sector from the Central
Government Budget. This approach is a necessity – despite the
formal Constitutional provision in regard to public health, if
the State public health services, which are a major component
of the initiatives in the social sector, are not to become entirely
moribund. The NHP-2002 has been formulated taking into
consideration these ground realities in regard to the availability
of resources.

2.2 EQUITY
2.2.1 In the period when centralized planning was accepted as
a key instrument of development in the country, the
attainment of an equitable regional distribution was
considered one of its major objectives. Despite this conscious
focus in the development process, the statistics given in Box-II
clearly indicate that the attainment of health indices has been
very uneven across the rural – urban divide.

Box II : Differentials in Health Status Among
States
Sector Population
BPL (%)

IMR/
Per 1000
Live
Births
(1999-
SRS)

<5Mort-
ality

per
1000
(NFHS
II)

Weight
For Age-

% of
Children
Under 3
years

(<-2SD)
MMR/
Lakh
(Annual
Report
2000)

Leprosy
cases
per

10000
popula-
tion

Malaria
+ve
Cases in
year 2000
(in
thousands)
India
26.1 70 94.9 47 408 3.7 2200
Rural
27.09 75 103.7 49.6 - - -
Urban
23.62 44 63.1 38.4 - - -
Better
Performing
States

Kerala 12.72 14 18.8 27 87 0.9 5.1
Maharashtra 25.02 48 58.1 50 135 3.1 138
TN 21.12 52 63.3 37 79 4.1 56
Low
Performing
States


Orissa 47.15 97 104.4 54 498 7.05 483
Bihar 42.60 63 105.1 54 707 11.83 132
Rajasthan 15.28 81 114.9 51 607 0.8 53
UP 31.15 84 122.5 52 707 4.3 99
MP 37.43 90 137.6 55 498 3.83 528

Also, the statistics bring out the wide differences between the
attainments of health goals in the better- performing States as
compared to the low-performing States. It is clear that national
averages of health indices hide wide disparities in public health
facilities and health standards in different parts of the country.
Given a situation in which national averages in respect of most
indices are themselves at unacceptably low levels, the wide
inter-State disparity implies that, for vulnerable sections of
society in several States, access to public health services is
nominal and health standards are grossly inadequate. Despite
a thrust in the NHP-1983 for making good the unmet needs of
public health services by establishing more public health
institutions at a decentralized level, a large gap in facilities still
persists. Applying current norms to the population projected for

the year 2000, it is estimated that the shortfall in the number of
SCs/PHCs/CHCs is of the order of 16 percent. However, this
shortage is as high as 58 percent when disaggregated for
CHCs only. The NHP-2002 will need to address itself to making
good these deficiencies so as to narrow the gap between the
various States, as also the gap across the rural-urban divide.

2.2.2 Access to, and benefits from, the public health system
have been very uneven between the better-endowed and the
more vulnerable sections of society. This is particularly true for
women, children and the socially disadvantaged sections of
society. The statistics given in Box-III highlight the handicap
suffered in the health sector on account of socio-economic
inequity.

Box-III : Differentials in Health status Among Socio-Economic Groups
Indicator Infant
Mortality/1000
Under 5
Mortality/1000
% Children
Underweight
India
70 94.9 47
Social Inequity

Scheduled Castes 83 119.3 53.5
Scheduled Tribes 84.2 126.6 55.9
Other
Disadvantaged

76 103.1 47.3
Others 61.8 82.6 41.1
2.2.3 It is a principal objective of NHP-2002 to evolve a policy
structure which reduces these inequities and allows the
disadvantaged sections of society a fairer access to public
health services.


2.3 DELIVERY OF NATIONAL PUBLIC HEALTH
PROGRAMMES
2.3.1 It is self-evident that in a country as large as India, which
has a wide variety of socio-economic settings, national health
programmes have to be designed with enough flexibility to
permit the State public health administrations to craft their own
programme package according to their needs. Also, the
implementation of the national health programme can only be
carried out through the State Governments’ decentralized
public health machinery. Since, for various reasons, the
responsibility of the Central Government in funding additional
public health services will continue over a period of time, the
role of the Central Government in designing broad-based
public health initiatives will inevitably continue. Moreover, it has
been observed that the technical and managerial expertise for
designing large-span public health programmes exists with the
Central Government in a considerable degree; this expertise
can be gainfully utilized in designing national health
programmes for implementation in varying socio-economic
settings in the States. With this background, the NHP-2002
attempts to define the role of the Central Government and the
State Governments in the public health sector of the country.

2.3.2.1 Over the last decade or so, the Government has relied
upon a ‘vertical’ implementational structure for the major
disease control programmes. Through this, the system has been
able to make a substantial dent in reducing the burden of
specific diseases. However, such an organizational structure,
which requires independent manpower for each disease
programme, is extremely expensive and difficult to sustain.
Over a long time-range, ‘vertical’ structures may only be
affordable for those diseases which offer a reasonable
possibility of elimination or eradication in a foreseeable time-
span.

2.3.2.2 It is a widespread perception that, over the last decade
and a half, the rural health staff has become a vertical
structure exclusively for the implementation of family welfare
activities. As a result, for those public health programmes
where there is no separate vertical structure, there is no
identifiable service delivery system at all. The Policy will address
this distortion in the public health system.

2.4 THE STATE OF PUBLIC HEALTH INFRA-STRUCTURE
2.4.1 The delineation of NHP-2002 would be required to be
based on an objective assessment of the quality and efficiency
of the existing public health machinery in the field. It would
detract from the quality of the exercise if, while framing a new
policy, it were not acknowledged that the existing public
health infrastructure is far from satisfactory. For the outdoor
medical facilities in existence, funding is generally insufficient;
the presence of medical and para-medical personnel is often

much less than that required by prescribed norms; the
availability of consumables is frequently negligible; the
equipment in many public hospitals is often obsolescent and
unusable; and, the buildings are in a dilapidated state. In the
indoor treatment facilities, again, the equipment is often
obsolescent; the availability of essential drugs is minimal; the
capacity of the facilities is grossly inadequate, which leads to
over-crowding, and consequentially to a steep deterioration in
the quality of the services. As a result of such inadequate
public health facilities, it has been estimated that less than 20
percent of the population, which seek OPD services, and less
than 45 percent of that which seek indoor treatment, avail of
such services in public hospitals. This is despite the fact that
most of these patients do not have the means to make out-of-
pocket payments for private health services except at the cost
of other essential expenditure for items such as basic nutrition.

2.5 EXTENDING PUBLIC HEALTH SERVICES
2.5.1 While there is a general shortage of medical personnel in
the country, this shortfall is disproportionately impacted on the
less-developed and rural areas. No incentive system attempted
so far, has induced private medical personnel to go to such
areas; and, even in the public health sector, the effort to
deploy medical personnel in such under-served areas, has
usually been a losing battle. In such a situation, the possibility
needs to be examined of entrusting some limited public health
functions to nurses, paramedics and other personnel from the
extended health sector after imparting adequate training to
them.

2.5.2 India has a vast reservoir of practitioners in the Indian
Systems of Medicine and Homoeopathy, who have undergone
formal training in their own disciplines. The possibility of using
such practitioners in the implementation of State/Central
Government public health programmes, in order to increase
the reach of basic health care in the country, is addressed in
the NHP-2002.

2.6 ROLE OF LOCAL SELF-GOVERNMENT
INSTITUTIONS

2.6.1 Some States have adopted a policy of devolving
programmes and funds in the health sector through different
levels of the Panchayati Raj Institutions. Generally, the
experience has been an encouraging one. The adoption of
such an organisational structure has enabled need-based
allocation of resources and closer supervision through the
elected representatives. The Policy examines the need for a
wider adoption of this mode of delivery of health services, in
rural as well as urban areas, in other parts of the country.

2.7 NORMS FOR HEALTH CARE PERSONNEL
2.7.1 It is observed that the deployment of doctors and nurses,
in both public and private institutions, is ad-hoc and
significantly short of the requirement for minimal standards of
patient care. This policy will make a specific recommendation
in regard to this deficiency.

2.8 EDUCATION OF HEALTH CARE
PROFESSIONALS

2.8.1 Medical and Dental Colleges are not evenly spread
across various parts of the country. Apart from the uneven
geographical distribution of medical institutions, the quality of
education is highly uneven and in several instances even sub-
standard. It is a common perception that the syllabus is
excessively theoretical, making it difficult for the fresh graduate
to effectively meet even the primary health care needs of the
population. There is a general reluctance on the part of
graduate doctors to serve in areas distant from their native
place. NHP-2002 will suggest policy initiatives to rectify the
resultant disparities.

2.8.2.1 Certain medical disciplines, such as molecular biology
and gene-manipulation, have become relevant in the period
after the formulation of the previous National Health Policy. The
components of medical research in recent years have
changed radically. In the foreseeable future such research will
rely increasingly on the new disciplines. It is observed that the
current under-graduate medical syllabus does not cover such
emerging subjects. The Policy will make appropriate
recommendations in respect of such deficiencies.

2.8.2.2 Also, certain speciality disciplines – Anesthesiology,
Radiology and Forensic Medicine – are currently very scarce,
resulting in critical deficiencies in the package of available
public health services. This Policy will recommend some
measures to alleviate such critical shortages.


2.9 NEED FOR SPECIALISTS IN ‘PUBLIC HEALTH’ AND

‘FAMILY MEDICINE’
2.9.1 In any developing country with inadequate availability of
health services, the requirement of expertise in the areas of
‘public health’ and ‘family medicine’ is markedly more than
the expertise required for other clinical specialities. In India, the
situation is that public health expertise is non-existent in the
private health sector, and far short of requirement in the public
health sector. Also, the current curriculum in the graduate /
post-graduate courses is outdated and unrelated to
contemporary community needs. In respect of ‘family
medicine’, it needs to be noted that the more talented
medical graduates generally seek specialization in clinical
disciplines, while the remaining go into general practice. While
the availability of postgraduate educational facilities is 50
percent of the total number of qualifying graduates each year,
and can be considered adequate, the distribution of the
disciplines in the postgraduate training facilities is
overwhelmingly in favour of clinical specializations. NHP-2002
examines the possible means for ensuring adequate availability
of personnel with specialization in the ‘public health’ and
‘family medicine’ disciplines, to discharge the public health
responsibilities in the country.

2.10 Nursing Personnel
2.10.1 The ratio of nursing personnel in the country vis-à-vis
doctors/beds is very low according to professionally accepted
norms. There is also an acute shortage of nurses trained in
super-speciality disciplines for deployment in tertiary care
facilities. NHP-2002 addresses these problems.

2.11 USE OF GENERIC DRUGS AND VACCINES
2.11.1 India enjoys a relatively low-cost health care system
because of the widespread availability of indigenously
manufactured generic drugs and vaccines. There is an
apprehension that globalization will lead to an increase in the
costs of drugs, thereby leading to rising trends in overall health
costs. This Policy recommends measures to ensure the future
Health Security of the country.

2.12 URBAN HEALTH
2.12.1.1 In most urban areas, public health services are very
meagre. To the extent that such services exist, there is no
uniform organizational structure. The urban population in the
country is presently as high as 30 percent and is likely to go up
to around 33 percent by 2010. The bulk of the increase is likely
to take place through migration, resulting in slums without any
infrastructure support. Even the meagre public health services
which are available do not percolate to such unplanned
habitations, forcing people to avail of private health care
through out-of-pocket expenditure.

2.12.1.2 The rising vehicle density in large urban agglomerations
has also led to an increased number of serious accidents
requiring treatment in well-equipped trauma centres. NHP-2002
will address itself to the need for providing this unserved urban
population a minimum standard of broad-based health care
facilities.

2.13 MENTAL HEALTH
2.13.1 Mental health disorders are actually much more

prevalent than is apparent on the surface. While such disorders
do not contribute significantly to mortality, they have a serious
bearing on the quality of life of the affected persons and their
families. Sometimes, based on religious faith, mental disorders
are treated as spiritual affliction. This has led to the
establishment of unlicensed mental institutions as an adjunct to
religious institutions where reliance is placed on faith cure.
Serious conditions of mental disorder require hospitalization and
treatment under trained supervision. Mental health institutions
are woefully deficient in physical infrastructure and trained
manpower. NHP-2002 will address itself to these deficiencies in
the public health sector.

2.14 INFORMATION, EDUCATION AND COMMUNICATION

2.14.1 A substantial component of primary health care consists
of initiatives for disseminating to the citizenry, public health-
related information. IEC initiatives are adopted not only for
disseminating curative guidelines (for the TB, Malaria, Leprosy,
Cataract Blindness Programmes), but also as part of the effort
to bring about a behavioural change to prevent HIV/AIDS and
other life-style diseases. Public health programmes, particularly,
need high visibility at the decentralized level in order to have
an impact. This task is difficult as 35 percent of our country’s
population is illiterate. The present IEC strategy is too
fragmented, relies too heavily on the mass media and does not
address the needs of this segment of the population. It is often
felt that the effectiveness of IEC programmes is difficult to
judge; and consequently it is often asserted that accountability,
in regard to the productive use of such funds, is doubtful. The

Policy, while projecting an IEC strategy, will fully address the
inherent problems encountered in any IEC programme
designed for improving awareness and bringing about a
behavioural change in the general population.

2.14.2 It is widely accepted that school and college students
are the most impressionable targets for imparting information
relating to the basic principles of preventive health care. The
policy will attempt to target this group to improve the general
level of awareness in regard to ‘health-promoting’ behaviour.

2.15 HEALTH RESEARCH
2.15.1 Over the years, health research activity in the country
has been very limited. In the Government sector, such research
has been confined to the research institutions under the Indian
Council of Medical Research, and other institutions funded by
the States/Central Government. Research in the private sector
has assumed some significance only in the last decade. In our
country, where the aggregate annual health expenditure is of
the order of Rs. 80,000 crores, the expenditure in 1998-99 on
research, both public and private sectors, was only of the order
of Rs. 1150 crores. It would be reasonable to infer that with such
low research expenditure, it is virtually impossible to make any
dramatic break-through within the country, by way of new
molecules and vaccines; also, without a minimal back-up of
applied and operational research, it would be difficult to assess
whether the health expenditure in the country is being incurred
through optimal applications and appropriate public health
strategies. Medical Research in the country needs to be
focused on therapeutic drugs/vaccines for tropical diseases,

which are normally neglected by international pharmaceutical
companies on account of their limited profitability potential.
The thrust will need to be in the newly-emerging frontier areas
of research based on genetics, genome-based drug and
vaccine development, molecular biology, etc. NHP-2002 will
address these inadequacies and spell out a minimal quantum
of expenditure for the coming decade, looking to the national
needs and the capacity of the research institutions to absorb
the funds.

2.16 ROLE OF THE PRIVATE SECTOR
2.16.1 Considering the economic restructuring under way in the
country, and over the globe, in the last decade, the changing
role of the private sector in providing health care will also have
to be addressed in this Policy. Currently, the contribution of
private health care is principally through independent
practitioners. Also, the private sector contributes significantly to
secondary-level care and some tertiary care. It is a widespread
perception that private health services are very uneven in
quality, sometimes even sub-standard. Private health services
are also perceived to be financially exploitative, and the
observance of professional ethics is noted only as an exception.
With the increasing role of private health care, the
implementation of statutory regulation, and the monitoring of
minimum standards of diagnostic centres / medical institutions
becomes imperative. The Policy will address the issues
regarding the establishment of a comprehensive information
system, and based on that the establishment of a regulatory
mechanism to ensure the maintaining of adequate standards
by diagnostic centres / medical institutions, as well as the

proper conduct of clinical practice and delivery of medical
services.

2.16.2 Currently, non-Governmental service providers are
treating a large number of patients at the primary level for
major diseases. However, the treatment regimens followed are
diverse and not scientifically optimal, leading to an increase in
the incidence of drug resistance. This policy will address itself to
recommending arrangements which will eliminate the risks
arising from inappropriate treatment.

2.16.3 The increasing spread of information technology raises
the possibility of its adoption in the health sector. NHP-2002 will
examine this possibility.

2.17 THE ROLE OF CIVIL SOCIETY
2.17.1 Historically, it has been the practice to implement major
national disease control programmes through the public health
machinery of the State/Central Governments. It has become
increasingly apparent that certain components of such
programmes cannot be efficiently implemented merely
through government functionaries. A considerable change in
the mode of implementation has come about in the last two
decades, with the increasing involvement of NGOs and other
institutions of civil society. It is to be recognized that
widespread debate on various public health issues has, in fact,
been initiated and sustained by NGOs and other members of
the civil society. Also, an increasing contribution is being made
by such institutions in the delivery of different components of
public health services. Certain disease control programmes

require close inter-action with the beneficiaries for regular
administration of drugs; periodic carrying out of pathological
tests; dissemination of information regarding disease control
and other general health information. NHP-2002 will address
such issues and suggest policy instruments for the
implementation of public health programmes through
individuals and institutions of civil society.

2.18 NATIONAL DISEASE SURVEILLANCE NETWORK
2.18.1 The technical network available in the country for
disease surveillance is extremely rudimentary and to the extent
that the system exists, it extends only up to the district level.
Disease statistics are not flowing through an integrated network
from the decentralized public health facilities to the
State/Central Government health administration. Such an
arrangement only provides belated information, which, at best,
serves a limited statistical purpose. The absence of an efficient
disease surveillance network is a major handicap in providing a
prompt and cost-effective health care system. The efficient
disease surveillance network set up for Polio and HIV/AIDS has
demonstrated the enormous value of such a public health
instrument. Real-time information on focal outbreaks of
common communicable diseases – Malaria, GE, Cholera and
JE – and the seasonal trends of diseases, would enable timely
intervention, resulting in the containment of the thrust of
epidemics. In order to be able to use an integrated disease
surveillance network for operational purposes, real-time
information is necessary at all levels of the health administration.
The Policy would address itself to this major systemic
shortcoming in the administration.

2.19 HEALTH STATISTICS
2.19.1 The absence of a systematic and scientific health
statistics data-base is a major deficiency in the current scenario.
The health statistics collected are not the product of a rigorous
methodology. Statistics available from different parts of the
country, in respect of major diseases, are often not obtained in
a manner which make aggregation possible or meaningful.

2.19.2.1 Further, the absence of proper and systematic
documentation of the various financial resources used in the
health sector is another lacuna in the existing health
information scenario. This makes it difficult to understand trends
and levels of health spending by private and public providers
of health care in the country, and, consequently, to address
related policy issues and to formulate future investment policies.

2.19.2.2 NHP-2002 will address itself to the programme for
putting in place a modern and scientific health statistics
database as well as a system of national health accounts.

2.20 WOMEN’S HEALTH
2.20.1 Social, cultural and economic factors continue to inhibit
women from gaining adequate access even to the existing
public health facilities. This handicap does not merely affect
women as individuals; it also has an adverse impact on the
health, general well-being and development of the entire
family, particularly children. This policy recognises the catalytic
role of empowered women in improving the overall health
standards of the community.

2.21 MEDICAL ETHICS
2.21.1 Professional medical ethics in the health sector is an area
which has not received much attention. Professional practices
are perceived to be grossly commercial and the medical
profession has lost its elevated position as a provider of basic
services to fellow human beings. In the past, medical research
has been conducted within the ethical guidelines notified by
the Indian Council of Medical Research. The first document
containing these guidelines was released in 1960, and was
comprehensively revised in 2001. With the rapid developments
in the approach to medical research, a periodic revision will no
doubt be more frequently required in future. Also, the new
frontier areas of research – involving gene manipulation,
organ/human cloning and stem cell research _ impinge on
visceral issues relating to the sanctity of human life and the
moral dilemma of human intervention in the designing of life
forms. Besides this, in the emerging areas of research, there is
the uncharted risk of creating new life forms, which may
irreversibly damage the environment as it exists today. NHP –
2002 recognises that this moral and religious dilemma, which
was not relevant even two years ago, now pervades
mainstream health sector issues.

2.22 ENFORCEMENT OF QUALITY STANDARDS FOR FOOD
AND DRUGS
2.22.1 There is an increasing expectation and need of the
citizenry for efficient enforcement of reasonable quality
standards for food and drugs. Recognizing this, the Policy will
make an appropriate policy recommendation on this issue.

2.23 REGULATION OF STANDARDS IN
PARA MEDICAL
DISCIPLINES
2.23.1 It has been observed that a large number of training
institutions have mushroomed, particularly in the private sector,
for para medical personnel with various skills – Lab Technicians,
Radio Diagnosis Technicians, Physiotherapists, etc. Currently,
there is no regulation/monitoring, either of the curriculae of
these institutions, or of the performance of the practitioners in
these disciplines. This Policy will make recommendations to
ensure the standardization of such training and the monitoring
of actual performance.

2.24 ENVIRONMENTAL AND
OCCUPATIONAL HEALTH
2.24.1 The ambient environmental conditions are a significant
determinant of the health risks to which a community is
exposed. Unsafe drinking water, unhygienic sanitation and air
pollution significantly contribute to the burden of disease,
particularly in urban settings. The initiatives in respect of these
environmental factors are conventionally undertaken by the
participants, whether private or public, in the other
development sectors. In this backdrop, the Policy initiatives,
and the efficient implementation of the linked programmes in
the health sector, would succeed only to the extent that they
are complemented by appropriate policies and programmes
in the other environment-related sectors.

2.24.2 Work conditions in several sectors of employment in the

country are sub-standard. As a result, workers engaged in such
employment become particularly vulnerable to occupation-
linked ailments. The long-term risk of chronic morbidity is
particularly marked in the case of child labour. NHP-2002 will
address the risk faced by this particularly vulnerable section of
society.

2.25 PROVIDING MEDICAL FACILITIES TO USERS FROM
OVERSEAS
2.25.1 The secondary and tertiary facilities available in the
country are of good quality and cost-effective compared to
international medical facilities. This is true not only of facilities in
the allopathic disciplines, but also of those belonging to the
alternative systems of medicine, particularly Ayurveda. The
Policy will assess the possibilities of encouraging the
development of paid treatment-packages for patients from
overseas.

2.26 THE IMPACT OF GLOBALIZATION ON
THE HEALTH SECTOR
2.26.1 There are some apprehensions about the possible
adverse impact of economic globalisation on the health sector.
Pharmaceutical drugs and other health services have always
been available in the country at extremely inexpensive prices.
India has established a reputation around the globe for the
innovative development of original process patents for the
manufacture of a wide-range of drugs and vaccines within the
ambit of the existing patent laws. With the adoption of Trade
Related Intellectual Property Rights (TRIPS), and the subsequent
alignment of domestic patent laws consistent with the

commitments under TRIPS, there will be a significant shift in the
scope of the parameters regulating the manufacture of new
drugs/vaccines. Global experience has shown that the
introduction of a TRIPS-consistent patent regime for drugs in a
developing country results in an across-the-board increase in
the cost of drugs and medical services. NHP-2002 will address
itself to the future imperatives of health security in the country,
in the post-TRIPS era.

2.27 INTER-SECTORAL CONTRIBUTION TO HEALTH
2.27.1 It is well recognized that the overall well-being of the
citizenry depends on the synergistic functioning of the various
sectors in the socio-economy. The health status of the citizenry
would, inter alia, be dependent on adequate nutrition, safe
drinking water, basic sanitation, a clean environment and
primary education, especially for the girl child. The policies and
the mode of functioning in these independent areas would
necessarily overlap each other to contribute to the health
status of the community. From the policy perspective, it is
therefore imperative that the independent policies of each of
these inter-connected sectors, be in tandem, and that the
interface between the policies of the two connected sectors,
be smooth.

2.27.2 Sectoral policy documents are meant to serve as a
guide to action for institutions and individual participants
operating in that sector. Consistent with this role, NHP-2002 limits
itself to making recommendations for the participants
operating within the health sector. The policy aspects relating
to inter-connected sectors, which, while crucial, fall outside the

domain of the health sector, will not be covered by specific
recommendations in this Policy document. Needless to say, the
future attainment of the various goals set out in this policy
assumes a reasonable complementary performance in these
inter-connected sectors.





2.28 POPULATION GROWTH AND HEALTH STANDARDS
2.28.1 Efforts made over the years for improving health
standards have been partially neutralized by the rapid growth
of the population. It is well recognized that population
stabilization measures and general health initiatives, when
effectively synchronized, synergistically maximize the socio-
economic well-being of the people. Government has
separately announced the `National Population Policy – 2000’.
The principal common features covered under the National
Population Policy-2000 and NHP-2002, relate to the prevention
and control of communicable diseases; giving priority to the
containment of HIV/AIDS infection; the universal immunization
of children against all major preventable diseases; addressing
the unmet needs for basic and reproductive health services,
and supplementation of infrastructure. The synchronized
implementation of these two Policies – National Population
Policy – 2000 and National Health Policy-2002 – will be the very
cornerstone of any national structural plan to improve the
health standards in the country.

2.29 ALTERNATIVE SYSTEMS OF MEDICINE
2.29.1 Under the overarching umbrella of the national health
frame work, the alternative systems of medicine – Ayurveda,
Unani, Siddha and Homoeopathy – have a substantial role.
Because of inherent advantages, such as diversity, modest cost,
low level of technological input and the growing popularity of
natural plant-based products, these systems are attractive,
particularly in the underserved, remote and tribal areas. The
alternative systems will draw upon the substantial untapped
potential of India as one of the eight important global centers
for plant diversity in medicinal and aromatic plants. The Policy
focuses on building up credibility for the alternative systems, by
encouraging evidence-based research to determine their
efficacy, safety and dosage, and also encourages certification
and quality-marking of products to enable a wider popular
acceptance of these systems of medicine. The Policy also
envisages the consolidation of documentary knowledge
contained in these systems to protect it against attack from
foreign commercial entities by way of malafide action under
patent laws in other countries. The main components of NHP-
2002 apply equally to the alternative systems of medicines.
However, the Policy features specific to the alternative systems
of medicine will be presented as a separate document.

3. OBJECTIVES
3.1 The main objective of this policy is to achieve an
acceptable standard of good health amongst the general
population of the country. The approach would be to increase
access to the decentralized public health system by
establishing new infrastructure in deficient areas, and by

upgrading the infrastructure in the existing institutions.
Overriding importance would be given to ensuring a more
equitable access to health services across the social and
geographical expanse of the country. Emphasis will be given to
increasing the aggregate public health investment through a
substantially increased contribution by the Central
Government. It is expected that this initiative will strengthen the
capacity of the public health administration at the State level
to render effective service delivery. The contribution of the
private sector in providing health services would be much
enhanced, particularly for the population group which can
afford to pay for services. Primacy will be given to preventive
and first-line curative initiatives at the primary health level
through increased sectoral share of allocation. Emphasis will be
laid on rational use of drugs within the allopathic system.
Increased access to tried and tested systems of traditional
medicine will be ensured. Within these broad objectives, NHP-
2002 will endeavour to achieve the time-bound goals
mentioned in Box-IV.

Box-IV: Goals to be achieved by 2000-2015
Eradicate Polio and Yaws 2005
Eliminate Leprosy 2005
Eliminate Kala Azar 2010
Eliminate Lymphatic
Filariasis
2015
Achieve Zero level growth
of HIV/AIDS
2007

Reduce Mortality by 50%
on account of TB, Malaria
and Other Vector and
Water Borne diseases
2010
Reduce Prevalence of
Blindness to 0.5%
2010
Reduce IMR to 30/1000
And MMR to 100/Lakh
2010
Increase utilization of
public health facilities from
current Level of <20 to
>75%
2010
Establish an integrated
system of surveillance,
National Health Accounts
2005
and Health Statistics.
Increase health
expenditure by
Government as a % of
GDP from the existing 0.9 %
to 2.0%
2010
Increase share of Central
grants to Constitute at
least 25% of total health

spending
2010
Increase State Sector
Health spending from 5.5%
to 7% of the budget
Further increase to 8%
2005
2010


4. NHP-2002 - POLICY PRESCRIPTIONS
4.1 FINANCIAL RESOURCES
4.1.1 The paucity of public health investment is a stark reality.
Given the extremely difficult fiscal position of the State
Governments, the Central Government will have to play a key
role in augmenting public health investments. Taking into
account the gap in health care facilities, it is planned, under
the policy to increase health sector expenditure to 6 percent of
GDP, with 2 percent of GDP being contributed as public health
investment, by the year 2010. The State Governments would
also need to increase the commitment to the health sector. In
the first phase, by 2005, they would be expected to increase
the commitment of their resources to 7 percent of the Budget;
and, in the second phase, by 2010, to increase it to 8 percent
of the Budget. With the stepping up of the public health
investment, the Central Government’s contribution would rise
to 25 percent from the existing 15 percent by 2010. The
provisioning of higher public health investments will also be
contingent upon the increase in the absorptive capacity of the
public health administration so as to utilize the funds gainfully.

4.2 EQUITY
4.2.1 To meet the objective of reducing various types of
inequities and imbalances – inter-regional; across the rural –
urban divide; and between economic classes – the most cost-
effective method would be to increase the sectoral outlay in
the primary health sector. Such outlets afford access to a vast
number of individuals, and also facilitate preventive and early
stage curative initiative, which are cost effective. In recognition
of this public health principle, NHP-2002 sets out an increased
allocation of 55 percent of the total public health investment
for the primary health sector; the secondary and tertiary health
sectors being targeted for 35 percent and 10 percent
respectively. The Policy projects that the increased aggregate
outlays for the primary health sector will be utilized for
strengthening existing facilities and opening additional public
health service outlets, consistent with the norms for such
facilities.

4.3 DELIVERY OF NATIONAL PUBLIC
HEALTH PROGRAMMES
4.3.1.1 This policy envisages a key role for the Central
Government in designing national programmes with the active
participation of the State Governments. Also, the Policy ensures
the provisioning of financial resources, in addition to technical
support, monitoring and evaluation at the national level by the
Centre. However, to optimize the utilization of the public health
infrastructure at the primary level, NHP-2002 envisages the
gradual convergence of all health programmes under a single
field administration. Vertical programmes for control of major

diseases like TB, Malaria, HIV/AIDS, as also the RCH and
Universal Immunization Programmes, would need to be
continued till moderate levels of prevalence are reached. The
integration of the programmes will bring about a desirable
optimisation of outcomes through a convergence of all public
health inputs. The Policy also envisages that programme
implementation be effected through autonomous bodies at
State and district levels. The interventions of State Health